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HEALTH

German health care: Everything that changes for patients in 2020

Living in Germany and using the health care system? Here's what you need to know about upcoming changes.

German health care: Everything that changes for patients in 2020
Photo: DPA

We recently reported how the health care system in Germany is set to become more digital in the coming years. Here we take a closer look at changes, as well as other things you should know about.

Extended medical on-call service

Since January 2nd, the medical on-call service (Ärztliche Bereitschaftsdienst) has been available around the clock by calling the number 116 117. After a recorded message, callers can choose whether they need medical assistance or want to make an appointment with a doctor. The on-call service is intended to relieve the burden on doctors and emergency departments.

The number should be used if people become sick when normal surgeries are closed and can’t wait until the next working day, but do not feel that emergency services need to be called.

The staff either connects the patient to a doctor by telephone, informs them about an open on-call practice nearby or sends a doctor to their home.

READ ALSO: How Germany plans to revamp emergency care to beat overcrowding

Measles vaccination

A child being vaccinated in Hanover. Photo: DPA

The measles vaccination will be compulsory in Kitas (day care centres/Kindergartens), schools, refugee accommodation and medical facilities from March 1st, 2020. Parents must prove that they have had their children vaccinated before being admitted to a day care centre or school. 

For children living in care, as well as employees in refugee homes or in the health sector, there is a transitional period until July 31st, 2021.

Parents who do not comply with the compulsory vaccination face a fine of up to €2,500 as well as being banned from Kitas or schools.

Digital changes

Germany’s health care system is set to be modernized after Health Minister Jens Spahn passed the Digital Supply Act (DVG), reported Welt.

Apps on prescription

For the first time doctors will be able to prescribe health-orientated digital apps to patients, which can then be reimbursed by the statutory health insurance. For example, developers are creating more specialized paid apps, such as those designed for conditions like diabetes.

The Federal Institute for Drugs and Medical Devices (BfArM) will check the quality and safety of the apps. The app developer must then prove within a year that the app improves care.

Spahn previously said the move was a “world first”. However, the move has come up against some criticism.

“I am very critical of the fact that the manufacturer initially receives approval without proof of benefit,” Maria Klein-Schmeink, health policy spokesperson for the Green party, told Welt.

She expects that doctors, too, will react “rather reservedly” to the apps. The legal framework for this development still has to be given the green light.

READ ALSO: How German health care is set to become more digital in 2020

Online consultation

The new laws mean that doctors can now receive money for speaking to patients through video consultations online.

Doctors will also be allowed to provide information about video and online consultations on their websites – before they had only been able to discuss these in private conversations.

Since the beginning of October, health insurance companies have been providing funding for doctors and psychotherapists to carry this out.

This format could be particularly useful for long journeys or for routine checks after operations, said Andreas Gassen, the head of the National Association of Statutory Health Insurance Physicians (KBV).

“The gold standard, however, will always be the personal contact between doctor and patient,” he added.

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

Electronic prescriptions

A prescription on a smartphone in Stuttgart. Photo: DPA

In order to reduce the amount of paperwork in the health care system, the new laws also aim to phase out the ‘pink paper prescription’ (rosa Papierrezept), which people are given from the doctor to get access to medication.

It’s set to be replaced by an electronic version. Various pilot projects across Germany have already been testing this move.

However, there are some technical hurdles to overcome before this can be rolled out.

The Federal Association of Pharmacists’ Associations (ABDA) is currently working on a uniform app that can be downloaded. According to the ABDA, 12,000 of some 15,000 pharmacy owners have already registered for it. 

But the paper form will not be abolished immediately.

“Having a smartphone must not be a prerequisite for obtaining medication,” said ABDA Vice President Mathias Arnold.

To cut down on bureaucracy, it should also be possible in future to prescribe other medical equipment such as hearing aids electronically.

Electronic sick note

The move to embrace the digital world continues with the arrival of the electronic certificate of incapacity to work (eAU) or sick notes.

This would be “a blessing” for the health insurance providers, the GKV-Spitzenverband (statutory health insurance association) says.

“This would finally put an end to all the paper,” the association said. Every year, some 77 million paper sick notes are issued nationwide – and three times – one for the cash register, one for the employer and one for the employee.

The Appointment Service and Pensions Act (TSVG), which came into force in May, stipulates that from 2021 doctors will only be able to submit certificates digitally to the health insurance companies.

Meanwhile, another law passed to limit bureaucracy says that companies should request the data of their sick employees from the health insurance companies electronically. Pilot projects for the eAU are already underway at various health insurance providers.

READ ALSO: How Germany plans to ditch paper sick notes for digital ones

Electronic patient records

From 2021 those with with statutory health insurance will be able to receive their electronic patient records (ePA) from their health insurance provider if they want it. The file will contain findings, diagnoses, vaccinations and doctor’s letters.

The patient can decide who gets access to the data, what information is stored, and decide what to delete from it.

However patient advocates have raised some concerns over data protection.

READ ALSO: German health care – everything you need to know

Before the electronic files becomes reality, Health Minister Spahn must address some of these issues.

Greens politician Klein-Schmeink says that all this “may still take some time”.

More than 70 million people rely on Germany’s statutory insurance system, representing 90 percent of the population. 

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HEALTH

What you should know about Germany’s plans to roll out e-prescriptions

Germany is taking a big step towards a more digital-friendly health system, with plans to roll out e-prescriptions nationwide. Here's what you should know.

A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony.
A person holds the e-Rezept app in a pharmacy in Oldenburg, Lower Saxony. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

What’s happening?

From January 1st 2022, people in Germany will receive their prescriptions digitally (known in Germany as an ‘e-Rezept’) from healthcare providers.

Patients should be able to get their prescription from their doctor via a QR code sent to an app, which can then be transmitted to a pharmacy. The pharmacy can then let the patient know whether their medicine is in stock (or if they want to order it), and when it is ready for collection. 

This model is to be mandatory for people with statutory health insurance from the start of 2022, replacing the good old paper prescription.

However, the QR code can also be given to the patient by the doctor on a piece of paper if a patient does not have access to or doesn’t want to use a smartphone. 

READ ALSO: The changes around doctors notes in Germany you should know 

How exactly will it work?

In theory this is the plan – you’ll visit the doctor or have a video consultation. After the examination, the doctor will issue you with an electronic prescription for the medication that has been prescribed to you. 

A prescription code is automatically created for each ‘e-Rezept’, which you will need so you can get the medicine at the pharmacy. As we mentioned above, patients in Germany can either open this QR code in the free e-prescription app developed by Gematik and the Health Ministry, or receive it as a printout from the doctor. 

Next, you can take the prescription QR code (either in the app or as a printout) to your pharmacy of choice to get the medication needed.

One of the major differences and timesavers under the new system is that you can also select the pharmacy you want to get the prescription from digitally, order the medication (if needed) and you’ll be alerted when the prescription is ready. You can also arrange to have it delivered if needed. 

A doctor’s signature is not required, as e-prescriptions are digitally signed. 

The aim is that it will save on paperwork, time at the medical office and trips to the pharmacy. 

Some patients have already been receiving digital prescriptions. The ‘e-Rezept’ was tested out successfully in selected practices and pharmacies with a focus on the Berlin-Brandenburg region of Germany. The test phase started on July 1st this year.

Pharmacies and doctors’ offices nationwide have also been given the opportunity to test the new system from the start of December. 

“This will enable practice providers and pharmacy management systems to better prepare for the mandatory launch on January 2022 1st,” said aponet.de, the official health portal site for German pharmacies

The new e-prescription app.
The new e-prescription app. Photo: picture alliance/dpa | Mohssen Assanimoghaddam

READ ALSO: 10 rules to know if you get sick in Germany

There is some leeway though – if there are technical difficulties, paper prescriptions can still be issued in individual cases until the end of June next year.

The National Association of Statutory Health Insurance Physicians estimates that it could take until mid-2022 until all users are equipped with e-prescription applications nationwide.

The obligation does not apply to privately insured people from January next year. Private insurance companies can decide voluntarily to make the preparations for their customers to use the e-prescription.

What’s this about an app?

To be able to receive and redeem prescriptions electronically, people with statutory health insurance need the Gematik ‘das e-Rezept’ app. 

One issue is that the app appears to only be available at the moment in German app stores. We’ll try and find out if there are plans to change this and widen out the access, but it seems likely for that to happen. 

Germany’s Covid-Warn app, for example, was initially only open to German app stores but was gradually widened out to many others. 

As mentioned above though, those who don’t have access to an app will be able to use the paper with the code on it to access their prescriptions. 

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

Has it all gone smoothly?

As you might expect, there have been a few hiccups. 

Originally, the introduction nationwide was planned for October but was postponed due to many providers not having all the tech requirements set up. 

Now though, more than 90 percent of the practice management systems have been certified by the Association of Statutory Health Insurance Physicians – a prerequisite to issue the e-prescriptions.

The e-prescription is part of Germany’s far-reaching plans to digitise and streamline the health care system.

The head of Gematik GmbH, Markus Leyck Dieken, recently spoke of a “new era” that is “finally starting for doctors and patients” in Germany. 

Useful vocabulary:

Prescription – (das) Rezept

Doctor’s office/practice – (die) Arztpraxis

To order – bestellen 

Pharmacy – (die) Apotheke

Video consultation – (die) Videosprechstunde

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